The sleepy town of Heartsdale, Georgia, is jolted into panic when Sara Linton, the town's pediatrician and coroner, finds Sibyl Adams, a young college professor, dead in the local diner. As well as being viciously raped, Sibyl has been cut: two deep knife wounds form a lethal cross over her stomach. But it's only once Sara starts to perform the postmortem that the full extent of the killer's brutality starts to become clear.

Police chief Jeffrey Tolliver — Sara's ex-husband — is in charge of the investigation, and when a second victim is found, crucified, only a few days later, he has to face the fact that Sibyl's murder wasn't a single personal attack: They're dealing with a sadistic rapist turned killer who is terrorizing rural Grant County.

Jeffrey isn't alone in his search. Lena Adams — the county's sole female detective — wants to see justice done since her sister was the first victim. Sara, too, cannot escape the terror. A secret from her past could hold the key to finding the killer — unless he finds her first.